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Lung Transplant
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Joshua Sonett, MD, Chief, General Thoracic Section, weighs in on national lung transplant debate

National media have been closely following the case of Sarah Murnaghan, a ten-year-old child with cystic fibrosis who desperately needs a lung transplant. According to the rules governing organ allocation, children under the age of twelve can be placed on the pediatric waitlist for donor lungs, but they are not eligible for adult lungs. Joshua Sonett, MD, provides perspective to the national discussion which has followed upon the heels of a court ruling permitting Sarah and another child to be placed on the adult waitlist, at least temporarily, and a decision by the Organ Procurement and Transplantation Network (OPTN) to allow children like Sarah to have their cases reviewed by a board of lung transplant surgeons, and potentially be placed on both pediatric and adult waitlists.

According to Dr. Sonett, the rules governing allocation of adult organs was revised about eight years ago to account for the severity of illness. But those changes only applied to adults and children over age 12. The current situation highlights the need to reconsider the rules for children as well, but the solution is far from clear, as divisions among the medical community make evident. Many experts agree that children who need lung transplants may be at an unfair disadvantage in the current system, but they also recognize that making continuous exceptions for individual patients is problematic.

Listen to Dr. Sonett's comments in a video on CBS News, and read his comments in a New York Times article, below.

Children added to adult lung transplant list amid outcry a dilemma for doctors
CBS News June 7, 2013

Vote Allows Children Under 12 Seeking Lung Transplant to Have Case Reviewed
New York Times June 10, 2013

Columbia study shows ECMO is effective in bridging patients to lung transplantation and recovery

NYPH/Columbia's ECMO and Lung Transplant teams have reported the best survival rates to date for ECMO-supported bridge to lung transplant.

Patients waiting for a lung transplant may develop severe respiratory failure while on the transplant waitlist and require mechanical ventilation. Traditionally, such patients rapidly become too sick and deconditioned to tolerate a transplant and they are soon removed from the waitlist.

The Columbia program is considered a leader in the field and has pioneered the use of extracorporeal membrane oxygenation (ECMO) as an artificial lung to temporarily support patients with severe respiratory failure. In many cases, ECMO provides adequate support without the need for mechanical ventilation, and sometimes even allows patients to get out of bed and exercise. This permits them to maintain or even improve their physical conditioning rather than allowing it to worsen, greatly increasing the likelihood that they will be successfully transplanted.

Results of experience at NYPH/Columbia were published in the Journal of Thoracic and Cardiovascular Surgery July 13, 2012. PDF File

First Ex Vivo Lung Transplant in NOVEL Trial

Frank D'Ovidio, MD, PhD
Frank D'Ovidio, MD, PhD

September, 2011: Frank D'Ovidio, MD, PhD, and members of the NYP/Columbia Lung Transplantation Program performed the first ex vivo transplant at this hospital, saving the life of 59-year-old Patricia Kingsbury. The innovative transplant was part of the recently opened NOVEL trial, which is testing a new method of restoring and repairing donor lungs that may have sustained damage.

Developed at the University of Toronto, the ex vivo method entails keeping the donor lungs outside the body for about four hours. During this time, the lungs are infused with a solution of oxygen and nutrients, and are carefully assessed for damage. In some cases, lungs that might have previously been deemed too poor for transplant can in fact be successfully replenished and repaired, rendering them usable. This technique has the potential to significantly increase the number of donor organs available for transplant — a benefit that could mean all the difference for patients like Patricia whose lives may well depend upon the availability of a donor organ.

See the NYP/Columbia blog and the WABC-7 News for more on this important trial.

NOVEL Lung Transplant Trial Enrolling Patients

Attention: Special Seminar for All Lung Transplant Candidates
Lung transplant candidates and their families are asked to attend a special seminar regarding the NOVEL trial.

Patients and families may attend one of the following sessions:
  • Tuesday, August 2, 2011
    2:30 - 3:30 pm
  • Thursday, September 15, 2011
    5:30 - 6:30 pm
  • Wednesday, October 26, 2011
    4:00 - 5:00 pm
Location:
Heart Centers Room 1 & 2
Milstein Hospital Building
177 Fort Washington Avenue
New York, NY 10032

For more information, please contact:
Jaya Tiwari
Phone: 212.342.1518
E-mail: jlt2144@columbia.edu

As of June 2011, an important trial is now testing a new method of preserving donor lungs before transplantation. This method could potentially increase the availability of donor organs.

The NOVEL Lung Trial (Normothermic Ex-Vivo Lung Perfusion as an Assessment of Extended/Marginal Donor Lungs) will run from June 2011 to March 2014, under the direction of Principal Investigator Frank D'Ovidio, MD, PhD.

Transplant surgeons at the University of Toronto have developed an effective method of preserving donor lungs outside of the body at body temperatures. Preclinical data shows that ex vivo perfusion with STEEN solution is as good, if not better than, the standard cold static preservation. The NOVEL study proposes to use the EVLP technique to improve donor lung assessment before transplant, and thereby safely increase the number of available lungs for transplant. If the lungs demonstrate a favorable ex vivo evaluation, the lungs will be transplanted into a patient.

Read here for more information about the NOVEL study.


Joshua Sonett, MD Runs NYC Marathon with Lung Transplant Patient

Joshua Sonett, MD Runs NYC Marathon with Lung Transplant Patient
Timothy Sweeney and his transplant surgeon, Joshua Sonett, MD, at the finish line at the New York City Marathon November 7, 2010. Timothy received a double lung transplant November 10, 2009.

November 7, 2010, Joshua R. Sonett, MD, Surgical Director of the Lung Transplant Program, joined Timothy Sweeney, who has cystic fibrosis, in running the NYC marathon. Dr. Sonett performed Timothy's double lung transplant just under a year ago.

NYP/Columbia Patients and Surgeons Run
NYC Marathon
Video: NYP/Columbia Patients and Surgeons Run NYC Marathon

Read more here.








ECMO Lung Support Improves Patient's Health, Making Way for Lung Transplant

The December 14, 2009, USA Today ran an article about Liesbeth Stoeffler, a cystic fibrosis patient who received lifesaving lung support with a device called ECMO (short for extracorporeal membrane osxygenation). According to the USA Today article, ECMO enabled Ms. Stoeffler's doctors Matthew Bacchetta, MD, MBA, MA, and David Lederer, MD, to remove her from the ventilator, thereby improving her health so that she could maintain eligibility for lung transplant, which she received at NYP/Columbia on July 20, 2009. The ECMO gave Ms. Stoeffler's lungs relief from the ventilator, improving her oxygen and carbon dioxide levels, ultimately bridging her to transplant. According to the article, Ms. Stoeffler's doctors pared down her ECMO equipment and she was able to take liquids and food, which helped her gain weight and strength. She could eventually sit up, talk and even use her laptop and iPhone. "About five days into it, she told me it was the best she'd felt in years," Dr. Bacchetta said.

Ventilators may cause damage to the lungs because they push air into the lungs. ECMO, short for extracorporeal membrane oxygenation, directly oxygenates the blood, and does not cause lung damage. Patients may move around, eat, and even undergo pulmonary rehabilitation while on ECMO. Doctors at Columbia have been using ECMO technology as both a bridge to transplant and a bridge to recovery, using it to treat patients with H1N1, pulmonary fibrosis, COPD, cystic fibrosis, and pneumonia.



First Lung Transplant at MSCHONY

Joshua R. Sonett, MD
Joshua R. Sonett, MD

We are proud to announce the first pediatric lung transplant performed entirely at Morgan Stanley Children's Hospital. Previously, it was necessary for children to visit the Milstein Hospital Building at NewYork-Presbyterian Hospital/Columbia University Medical Center for the surgery and post-operative care. This milestone was made possible by interdisciplinary collaboration, including the support of the adult lung transplant team, as well as by resources available through the newly opened Laura Rothenberg Bronchoscopy-Endoscopy Center. Thanks to these advances, our pediatric lung patients can now expect the very best care available in the comforting and convenient setting of Morgan Stanley Children's Hospital.

Selection Criteria Expand for Cystic Fibrosis Lung Transplant

NewYork-Presbyterian Hospital has taken a leadership role in perfecting techniques and patient selection criteria for lung transplantation in patients with cystic fibrosis (CF). As a result, the Hospital is home to the largest CF lung transplant program in New York City. Leveraging this experience, the Hospital has now expanded the program to include patients under the age of 18 years. Although current management strategies reasonably control the disease into adulthood in most pediatric patients, lung transplantation may offer extended survival in pediatric patients with advancing disease who have severe and irreversible airflow obstruction.

The OPTN/UNOS Lung Allocation Score (LAS) System

In 2005, the U.S. Organ Procurement and Transplantation Network (OPTN) and its non-profit funding agency, United Network for Organ Sharing (UNOS), changed the nation's method of allocating organs to transplant candidates. The new method, involving a scoring system to help determine position on the organ waiting list, replaced an older system allocating organs on a first-come first-serve basis.

Click here to read more.

GER and Lung Transplant Dysfunction/Rejection

Frank D'Ovidio, MD, PhD
Frank D'Ovidio, MD, PhD

Highly effective treatments can successfully protect patients against the threat of the acute form of rejection that occurs immediately after transplant surgery. Yet even the best medical therapies are powerless against the tide of chronic rejection, which slowly and steadily undermines the health of over half of lung transplant patients during the first three- to five years after transplantation. Frank D'Ovidio, MD, PhD, has shed light on the role of gastro-esophageal reflux (GER) as one of the causes of chronic lung transplant dysfunction, and/or chronic rejection.




Columbia Lung Transplant Research Program

Lady at Microscope The Lung Transplant Program is leading the effort to improve outcomes in life-threatening lung diseases. Our research has contributed to recent advances in the understanding of advanced lung disease and lung transplantation including innovative medical and surgical treatments yielding improved quality-of-life and survival for patients. These achievements have been most notable in the areas of emphysema, idiopathic pulmonary fibrosis, pulmonary arterial hypertension, and cystic fibrosis, both before and after lung transplantation.

A Medicare Certified Lung Transplant Program

The NewYork-Presbyterian Lung Transplant Program at Columbia University Medical Center has received Medicare certification for lung transplantation. Medicare covers eligible patients who enter our program for preoperative evaluation, lung transplant surgery and postoperative care.


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